Full text of "Diseases Of The Nose Throat And Ear"

TRACHEOSTOMY                                    171

are tied with the head extended the tube may become loose on flexion
when the muscles relax. The safest way is to stitch it to the skin with
2/0 silk.

3. Removal of Secretions. Excess secretions occur after a tracheostomy since
the trachea is exposed to^gajk^^r^aj^and tne tube acts as a foreign body and
stimulates the formation of secretions. During the first 48 hours secretions
should be removed half-hourly and thereafter ever^l jorJLhours. The nurse
should wear sterile gloves. A sterile rubber catheter is attached to one limb of
the Y-shaped plastic connector from the suction apparatus and the sterile
catheter is inserted into the tracheostomy tube by means of sterile artery
forceps. She then places her thumb over the open limb of the Y-shaped
connection to close the air entry into the suction apparatus and withdraws the
catheter. This manoeuvre should not take more than 10 seconds or else the
patient will be rendered hypoxic. This is repeated until no further secretions
remain.

4. Humidification. This is necessary to prevent crusting of the secretions and
is done most simply by instilling normal saline down the tracheostomy tube.
Before suction 5 ml of normal saline are dripped down the tube, suction is
then performed and afterwards 5 ml of normal saline are dripped down the
tube and left in the tracheobronchial tree.

5.  Changing the Tube. T